Symptoms of Lung Cancer Emergencies: When to Go to the Hospital

It can be difficult to recognize the signs and symptoms of an emergency with lung cancer, but there are several you should know. Difficulty breathing, coughing up blood, a change in mental status, a fever, feeling lightheaded, or sudden leg weakness with or without bowel or bladder problems should prompt you to call 911. That said, it can be hard to recognize serious symptoms amidst the "normal" symptoms of shortness of breath and chest pain many people experience with lung cancer.

Since emergencies don't necessarily mean a cancer is terminal, and these symptoms may occur even with a highly curable lung cancer, it's important that everyone living with the disease (and their loved ones) know when to recognize the warning signs. with prompt care, even serious conditions can often be treated when caught early.

Amidst the symptoms many people cope with related to lung cancer and lung cancer treatments, which ones are a sign of an emergency that should prompt you to call 911?


When Should You Call 911 with Lung Cancer?

signs and symptoms of emergencies with lung cancer
When should you call 911 when you have lung cancer?. Photo©leaf

You may wonder when you should call 911 if you have lung cancer. After all, if you look at a generic list of reasons to call an ambulance, many are symptoms that people with lung cancer cope with every single day.

Your oncologist may have discussed oncology conditions that could result in an emergency. Things such as blood clots, a collapsed lung, and spinal cord compression from bone metastases. Even so, in a crisis it can be helpful to watch for specific symptoms, rather than run through a list of diagnostic possibilities. This article lists some of the symptoms which should prompt you or a loved one to call 911.

Keep in mind that in an emergency, time is critical. It's usually best to call 911 first, and then let the emergency response team get in touch with your physician. (Better yet, ask your oncologist what she recommends before you have an emergency.)

Many people hesitate to call 911. They don't want their call to be a "false alarm" and feel like a hypochondriac. They may not want to bother the paramedics if they aren't certain their symptoms are life-threatening. You are not bothering anyone by calling 911. The emergency response team is awake and waiting for a call, and your oncologist would certainly want you to call 911 if you are concerned.

Ask yourself: "What's the worst thing that could happen?" If you call and all's well, you stay home or you can go home if your symptoms aren't considered an emergency in the emergency room. If you don't call and your symptoms are life-threatening? Enough said.

Perhaps the most reliable sign that you need emergency care, is your gut feeling. If something feels different and is frightening you, call. Intuition speaks loudly, and only you know what feels normal for your body—or not. Here are a few tips on how to call 911 effectively.


Difficulty Breathing

New or worsening shortness of breath is an emergency with lung cancer. Photo©Sasha_Suzi

Many people if not most with lung cancer experience some breathing difficulty, so how can you know when your symptoms are an emergency?

If you are feeling frightened by your breathing, you should call 911. If trying to breathe becomes tiring, your symptoms are likely very serious. Symptoms such as a sudden onset of a sudden change in breathing, or a bluish discoloration of your skin and lips (cyanosis,) are a reason to call. A tightening of the neck muscles while breathing (referred to as "the use of accessory muscles") raises the chance that your symptoms are serious.

If you aren't sure how bad your breathing is, have someone count and record the number of breaths you take each minute. A normal respiratory rate is 20 breaths per minute or less at rest, while a respiratory rate over 24 may indicate a very serious condition. Respiratory rate has been called the ignored vital sign. and is very important in predicting serious medical events. In fact, a recent study found that an increase in respiratory rate was a better predictor than blood pressure or heart rate in determining who was stable and not in the intensive care unit.

As noted earlier, trust your gut. Even if your breathing rate is normal and your skin is pink, a sensation of shortness of breath, especially if it is causing you to worry, should be checked out immediately.


Coughing up Blood

Coughing up blood (other than a very small amount) is a reason to call 911 with lung cancer. Photo©sb-borg

Coughing up blood, even a small amount, should prompt you to call 911. Coughing up even a teaspoon of blood is a medical emergency. It may not look like a lot of blood, but keep in mind that coughing up 100 cc of blood, or 1/3 of a cup of blood (called massive hemoptysis) is considered a life-threatening emergency with a mortality (death) rate of over 30 percent.  

The problem is that bleeding in this area can quickly lead to airway obstruction (inability to get air into the lungs), aspiration (breathing the blood into the lungs), and a severe drop in blood pressure. Coughing up smaller amount than this can become serious very quickly, so you should be alert even if you notice just a drop of two on a tissue.

Among people who don't have lung cancer, there are many potential reasons for coughing up blood. Yet with lung cancer, this is often caused by a tumor growing into a vital area such as a blood vessel, or low platelets due to chemotherapy.

Don't wait. Call 911.


Chest Pain

Chest pain is a reason to call 911 with lung cancer. Photo©KatarzynaBialasiewicz

Chest pain, or what feels like "lung pain" can be an emergency for people with lung cancer. Not only are there many possible causes of chest pain related to lung cancer and cancer treatments, but people with cancer can develop heart disease as well. It's easy to forget amid treatment that people with lung cancer suffer from the same medical concerns as people without lung cancer when it comes to heart disease, and many treatments for cancer can actually increase this risk. (Some chemotherapy drugs, as well as radiation to the chest, can cause heart disease.)

The sudden onset of chest pain is a reason to call 911, and unlike instructions given to people without cancer to watch for dull, crushing pain, sharp pain can be just as serious for people with cancer.

Being aware of what is normal for you as far as symptoms is extremely important. Chest pain is common for people with lung cancer, whether related to post-thoractomy pain syndrome due to lung cancer surgery, pleuritic chest pain due to a pleural effusion, or other causes. Some people find it helpful to rank their pain with a number. For example, if the pain you are experiencing would be considered a 5 on a scale of 1 to 10 with regards to severity, and your "usual" pain level is a 3, you may wish to call 911.


Sudden Change in Mental Status

A sudden change in mental status can be an emergency with lung cancer. Photo©goldenKB

A sudden change in mental status can be an emergency for people living with lung cancer. There are many possible causes of confusion, including hypercalcemia of malignancy, but the important thing is not determining a cause, but being ready to call 911 if a person is truly confused.    

Symptoms may include hallucinations, agitation, and anything you would interpret as  confusion, or "being off" as a teen would say. Sometimes it's hard to tell if a person is truly confused, or if they are experiencing a side effect of a medication, or simply anxious or in pain. If you have any doubt, call 911.


Fainting or Severe Lightheadedness

Fainting or severe lightheadedness is a reason to call 911 with lung cancer. Photo©miriam-doerr

Loss of consciousness (syncope) or a feeling like you may lose consciousness, is a reason to call 911 with lung cancer. There are many complications of lung cancer involving several body systems that can cause this symptom, but the important thing is getting medical attention as soon as possible.

Your family and friends should be aware of when to call 911 if you are unable to let them know—such as in this scenario. Share with your loved ones this list of symptoms which suggest an emergency and have a list of your current diagnosis, medications, and treatments handy in the event someone else needs to speak for you. Don't assume the paramedics or even the hospital, will have this information. (Sometimes an ambulance will take a person to a hospital other than their usual hospital for a number of reasons.)

Check out these signs and symptoms that you are about to faint and watch for these symptoms:

  • Sweating
  • Confusion
  • Sudden decrease in hearing
  • A sensation of tunnel vision
  • Nausea
  • Flushing, and
  • Trembling

If you are feeling faint, alert a family member to call 911, and get into a position in which you won't be injured if you lose consciousness. It's often recommended to sit down with your head between your knees, but even this could be dangerous as a fall from a chair could risk injury. Don't wait to see if your symptoms pass, even if you believe there is a good reason for your symptoms.


Face, Neck, or Tongue Swelling

Face, neck, or tongue swelling may be an emergency with lung cancer. Photo©geargodz

 Anaphylactic shock, the most severe form of allergic reaction, often accompanied by a profound drop in blood pressure, is an emergency for people with lung cancer. With the array of medications many people are on during lung cancer treatment—many of which can cause allergic reactions—any sign of a serious allergic reaction should be heeded.

A special type of allergic reaction called angioedema can occur in people using chemotherapy drugs such as Taxol (paclitaxel) This often causes profound swelling of the face, especially the skin around the eyes and the tongue. With both of these conditions, people may develop intense itching, wheezing, weakness, and eventually unconsciousness. 

Superior vena cava syndrome may also be a medical emergency for people with lung cancer. With this syndrome, pressure on nearby structures from a tumor near the top of lungs can cause a feeling of fullness in the head, dilated neck veins, and chest swelling.


Sudden Leg Weakness/Numbness or Loss of Bowel/Bladder Control

Sudden leg numbness or weakness or loss of bladder/bowel control could indicate cauda equina syndrome. Photo©Pedro Jose Perez

Spinal cord compression (SCC) due to lung cancer that has spread to bone, can lead to a medical emergency—or at least, a situation in which quick treatment may help to preserve function. Symptoms of SCC often begin with pain in the back or neck.

Serious weakness or numbness of an extremity (or two) and loss of bowel or bladder control due to SCC is referred to as "cauda equina syndrome." This is a serious emergency which should prompt calling 911.

There are several ways in which spinal cord compression may occur in people with lung cancer, but the important thing to know is that this is an emergency. Even in cancers with a poor survival rate, emergency surgical treatment may be able to preserve function of the legs, bowel, and bladder for the time that is left.



A fever can be an emergency with lung cancer.©tab1962

A fever can be a medical emergency with lung cancer, but the temperature at which this becomes an emergency will vary between people, and what treatments are being given.

We list this as an emergency because despite having good antibiotics, there are lung cancer survivors every year who don't make it to the ER in time for antibiotics to work.

A level of 101 F (or 100.5 F) is often cited as the level at which to at least call your doctor, but this will be different for everyone. Treatments such as chemotherapy for lung cancer, can lower the ability of the body to fight infection, and antibiotics that would ordinarily be used for some people, may not be effective; never use an old prescription for antibiotics that you have on hand.

Sepsis and septic shock syndrome are clear examples of emergencies for which people with lung cancer should call 911. In addition to a fever, people often have other symptoms, such as lightheadedness, a rapid heart rate, confusion, and shaking. It's important to note that some people with sepsis, instead of having a fever, have a low body temperature (hypothermia), so a normal temperature is not necessarily a reassuring sign with respect to an infection.

Talk to your doctor about what your "warning" temperature should be ahead of time. If you are on chemotherapy, be extra alert for a fever. Even if your white blood cell count is normal or low normal, it's thought that, in some cases, the white blood cells people have may not work as well during chemotherapy.


Sense of Impending Doom or "Sixth Sense"

A sense of doom may be a reason to call 911 with lung cancer. Photo©VBaleha

One difficult to define reason to call 911, is simply your intuitive sense that something really bad is happening to you. It may be a combination of symptoms you are feeling, or a sudden deep fear of what is happening in your body. Trust your instinct. There is still much we don't understand in medicine, but our bodies often find ways of letting us know when we are in dire need of help.

sense of impending doom has actually been studied in medicine, and this research indicates that a sense of impending doom is common in people before a heart attack, before major drops in blood pressure, and before seizures.


Preparing for an Emergency

Prepare ahead for emergencies.©_ba_

Just as people plan for a tornado, it is helpful to plan.for a medical emergency. As with a natural disaster, most people are not thinking as clearly as they ordinarily would a the time the emergency occurs.

Have phone numbers ready, and a phone nearby if you suspect your symptoms are changing in any way

Decide how aggressive you would like to be ahead of time. For example, are you aiming at a cure or rather, to extend some quality of life. If you have completed advance directives make sure these are handy. In an ideal world, the hospital should have all necessary records. Still, there are times that—due to a large inflow of patients—someone will be diverted to another hospital.

Have a list of family contacts in a convenient spot  One woman with lung cancer kept a small "overnight" bag packed with essentials such as contact information. She stated that it didn't feel morbid to her, because she had done the same thing when she was pregnant, knowing that when labor began she would likely forget many important things.

Have a treatment summary along with your other emergency supplies. If your ambulance is diverted, this could save valuable time during which the emergency room staff tracks down your doctors and information.  

If symptoms come on fast, call 911 first. Let the emergency medical practitioners and hospital emergency room staff do the legwork in tracking down your doctors.


Emergency Symptoms at the End of LIfe

Decide ahead of time if you want emergency care at the end of life. Photo©Spotmatik

Unfortunately, many people end up in the hospital at the end of life, even if it had been their desire to die at home. If this is your desire, discuss the circumstances under which you would consider hospitalization carefully with your loved ones, before you are faced with a crisis (see below). There may be situations in which you may truly wish to be hospitalized.

First, it can help to define a few terms. DNR means do not resuscitate. This means that you do not want emergency personnel to do CPR(compress your heart or shock your heart if you should have an abnormal heart rhythm that would lead to death). DNI means do not intubate. This means that you would not want emergency medicine professionals to place a tube allowing a respirator to breathe for you. In most cases, patients opt for a DNR order which covers both. It is important to understand these situations carefully before making these decisions for a few reasons. A cardiac arrest does not necessarily mean that your heart has stopped. Sometimes even a small heart attack can result in an abnormal heart rhythm which could be fatal unless resuscitation (such as a shock) is given. Likewise, sometimes a crisis can be averted by using a breathing tube for a period of time.

If you have a DNR or DNI order, make sure you have a copy of this on hand, and that your family is aware of your decision. CPR is rarely successful when someone has terminal cancer, but in some states, emergency responders are required to do CPR even if a CPR order exists. 

In addition to DNR and DNI, it is very important to talk about your wishes regarding hospitalization at the end of life. ​There are many symptoms at the end of life that may require interventions other than resuscitation or intubation. For example, you may want to have your symptoms (such as severe pain) treated even if you have a DNR/DNI order in place.

While many people complete advance directives, there is no formal DNH (do not hospitalize) legal document. In order to avoid unnecessary hospitalization at the end of life it is crucial for patients to make a decision beforehand about whether, and under what circumstances, they would consider being hospitalized. If you are on hospice, your hospice team can help you express your desires and make these decisions.

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